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Medical Journal of Malaysia ; 77(Supplement 3):30, 2022.
Article in English | EMBASE | ID: covidwho-2093164


Introduction: The outbreak of COVID-19 has rapidly evolved to global pandemic since December 2019. Kidney injury is commonly associated with COVID-19 infection. The majority of reports strongly support that acute tubular injury is the primary lesion driving AKI in COVID-19. Our objective of this study is to identify the incidence of proteinuria and microscopic hematuria in COVID-19 patients admitted to Hospital Sultanah Bahiyah, Alor Setar. Material(s) and Method(s): This is a single centred, retrospective cross-sectional study examining the records of patients infected with COVID-19 admitted to Hospital Sultanah Bahiyah from September 13 till December 28, 2020. We excluded patients with pre-existing medical illnesses. These patients had urine dipstick tests done upon admission. Result(s): A total of 160 patients were included in this study. The mean age was 34.6 years, 43.8% were male and 56.2% were female patients. The median serum creatinine level was 68 mumol/L. Patients were categorised into different severity of COVID-19 infection on admission, 46% category 1, 22% category 2, 18% category 3, 13 % category 4, 1% category 5. The incidence of proteinuria and microscopic hematuria were 20.3% and 14.4% respectively on admission. The incidence of combined proteinuria and microscopic hematuria was 5.0%. Conclusion(s): In our study, proteinuria and microscopic hematuria were relatively common in different categories of COVID-19 infection even without preexisting chronic illnesses.The incidence of proteinuria and microscopic hematuria in our study are comparable to other studies. More data is needed to distinguish patients who had preexisting proteinuria and microscopic hematuria prior to presentation from those developed denovo in hospital.

Endocrine Practice ; 27(6):S63, 2021.
Article in English | EMBASE | ID: covidwho-1859542


Introduction: Starvation ketoacidosis represents one of the three metabolic acidoses caused by the accumulation of ketone bodies within the bloodstream. Outside of late pregnancy, it is a relatively rare condition. In late pregnancy, the placental production of the hormones estrogen, cortisol, and human placental lactogen combined with increased lipolysis causes greater insulin resistance and an overall catabolic state which improves nutrient availability for vital fetal growth. However, this also allows for a magnified response to fasting that results in increased ketone production and in rare cases “accelerated starvation.” In this case, we present a 25-year-old pregnant patient who presented with nausea, vomiting, and poor oral intake, who was found to be in starvation ketoacidosis. Case Description: A 25-year-old G2P1001 cis female with a previous medical history of migraines presented at 33 weeks gestation with nausea, vomiting, and poor oral intake for four days prior to admission in the setting of COVID-19 infection. Patient presented hemodynamically stable and in no acute distress. Fetal non stress test on admission was reactive. Initial lab work revealed a glucose of 95, anion gap of 21, and a bicarbonate level of 7. A beta hydroxybutyrate (BHB) level was elevated at 5.26. Arterial blood gas showed a pH of 7.2 and a PCO2 of 23, consistent with an anion gap metabolic acidosis. Urinalysis revealed 3+ ketones. Overall labs were consistent with starvation ketoacidosis and the patient was immediately resuscitated with dextrose containing intravenous fluids and an insulin drip to help shunt away from ketoacidosis. Her BHB rapidly downtrended to 1.28 within 12 hours and within 24 hours it normalized. Her metabolic acidosis continued to improve throughout her hospitalization. She was able to tolerate a regular diet prior to being discharged home. A few weeks later, she had an uncomplicated full term delivery of a healthy baby. Discussion: Starvation ketoacidosis outside of pregnancy is rare and takes at least two weeks to manifest as a mild ketoacidosis. In pregnancy, patients are in an insulin resistant state which increases with gestational age, making them prone to ketoacidosis particularly in the second and third trimesters. Ketoacidosis in pregnancy is not only harmful for the pregnant individual, but for the developing fetus as well. Ketones can cross the placental barrier, leading to neurological impairment and even fetal demise if the acidosis is not addressed quickly. Prompt treatment with IV fluids, dextrose, and insulin is imperative to prevent neurodevelopmental compromise. Patients with appropriate and timely treatment can continue on to have uncomplicated pregnancies and deliveries.

Kidney International Reports ; 7(2):S292, 2022.
Article in English | EMBASE | ID: covidwho-1707930


Introduction: In Malaysia, the overall prevalence of Chronic Kidney Disease (CKD) is 15.48%1. The incidence of patients with end-stage renal disease (ESRD) requiring dialysis has been growing rapidly in Malaysia from 18 per million population (PMP) in 1993 to 231 PMP in 20132. From 2007 to 2016, the acceptance rate for both hemodialysis and peritoneal dialysis nearly doubled while the prevalence rate had increased by more than two-fold.3Early observational studies reported lower peritonitis rates with double versus single-cuffed catheters.4However, Eklund B et al. showed that there is no significant difference in terms of catheter survival, exit site infection and peritonitis.5Exit-site infection (ESI) is a common complication of peritoneal dialysis (PD) and is one of the important risk factors in PD-related peritonitis and technical failure.6In addition, exit site infection is an independent risk factor for early onset peritonitis. Early onset peritonitis on the other hand, is identified as an independent risk factor for mortality and technique failure in PD patients.7 Our objective of this study is to identify the incidence of exit site infection and early onset peritonitis among patients whom had their tenckhoff catheter inserted in Hospital Sultanah Bahiyah from January 2021 till June 2021. Methods: This is a single centered, retrospective observational study which examines the incidence of early onset exit site infection in the first 3 months and early onset peritonitis in the first 3 months for patients on newly inserted single or double cuffed tenckhoff catheters. All patients had their tenckhoff catheter inserted from 1stof January 2021 till 31stof June 2021 were recruited. The catheters are inserted by Nephrologists under Y-Tech peritoneoscope guidance in the operation theatre. Coiled Dacron cuffed catheters were used. I-series coiled PD catheter from MEDCOMP USA was used for single cuffed catheter while Argyle Curl Cath Peritoneal Catheters from MEDTRONIC USA was used for double cuffed catheter. Results: A total of 62 patients were included, 35 patients had double cuffed catheter inserted while 27 patients had single cuffed catheter inserted. One patient who had single cuffed catheter inserted was excluded from this study due to malfunctioning of tenckhoff catheter postoperatively. The mean age for single cuffed catheter and double cuffed catheter patients were 50.3 and 55.8 years old respectively. Among the single cuffed catheter patients, 12(44%) were female while 15(56%) were male. Among the double cuffed catheter patients, 19(54%) were female while 16(46%)were male. The incidence of exit site infection for single cuffed catheter was 2(8%) while double cuffed catheter was 6(17%) The incidence of early onset peritonitis for single cuffed catheter and double cuffed catheter were 4(15%) and 11(31%) respectively. Conclusions: There is a higher incidence of early onset exit site infection and early onset peritonitis among patients with double cuffed tenckhoff catheter. Our study has limitation due to small sample size as the study being conducted during the height of COVID19 pandemic. Further study would be needed to recruit more patients over longer duration to ascertain late onset exit site infection, peritonitis and the long term catheter survival among single and double cuffed tenckhoff catheter. No conflict of interest